摘要
目的探讨床旁心肺超声在急诊室心源性肺水肿患者无创正压通气疗效评价中的作用。方法回顾性分析急诊室无创正压通气治疗心源性肺水肿患者的临床资料和床旁快速心肺超声特征。根据临床结局,分成无创正压通气治疗成功组和无创正压通气治疗失败组,比较两组之间心肺超声参数,如肺部超声评分、肺实变的比例、下腔静脉最大直径、左心室射血分数(EF)、左心室长轴运动(MAPSE)、右心室长轴运动(TAPSE)、二尖瓣舒张早期的最大流速(E),组织多普勒测定二尖瓣环和三尖瓣环侧壁收缩期最大运动速率(Sm)和二尖瓣舒张早期运动速率(e’),左心室E/e’和肺动脉收缩压(SPAP),以及发生房颤的比例。应用单因素和多因素Logistic回归分析无创正压通气治疗失败的影响因素。运用受试者特征曲线(Receiver operating characteristic curve,ROC)评价心肺超声参数预测NPPV治疗失败的效能。结果共纳入66例患者,其中NPPV治疗成功组44例(66.7%),NPPV治疗失败组22例(33.3%)。与无创正压通气治疗成功组比较,无创正压通气治疗失败组的肺部超声评分、肺实变的比例、左心室的E/e’、SPAP、发生房颤的比例和血肌酐水平明显升高,右心室Sm和PaO2/FiO2显著降低,差异均有统计学意义(P<0.05),其他超声参数如EF、MAPSE、左心室的Sm和TAPSE在两组之间的差异无统计学意义(P>0.05)。经多因素Logistic回归分析显示,肺超评分、左心室的E/e’和肺动脉收缩压是无创正压通气治疗失败的独立危险因素,其预测无创正压通气治疗失败的ROC曲线下面积(AUC)分别为0.802、0.783和0.852。结论床旁心肺超声获取的肺部超声评分、左心室的E/e’和肺动脉收缩压对急诊室心源性肺水肿无创正压通气的疗效有较好的评估价值。
Objective To explore the role of bedside cardiopulmonary ultrasound in the evaluation of non-invasive positive pressure ventilation(NPPV)in patients with cardiaogenic pulmonary edema in emergency department.Methods The clinical data and characteristics of bedside rapid cardiopulmonary ultrasound in patients withcardiaogenic pulmonary edema treated with NPPV in the emergency department were retrospectively analyzed.The following ultrasound parameters,including lung ultrasound score,the ratio of lung consolidation,diameter of inferior vena cava,left ventricular ejection fraction(LVEF),the mitral annular systolic displacement(MAPSE)and tricuspid annular systolic displacement(TAPSE),the peak Doppler velocities of the early diastolic mitral(E),the tissue velocity imaging of left ventricular and right ventricular(Sm),the tissue Doppler of the early diastolic velocity of the mitral annulus(e’),the average E/e’ratio of left ventricular,systolic pulmonary artery pressure(SPAP)and the ratio of atrial fibrillation,,were determined.All of the parameters combined with clinical parameters were compared between the non-invasive ventilation success group and non-invasive ventilation failure group.Univariate and multivariate logistic regression analysis were used to screen out the risk factors by taking the failure of NPPV treatment as the dependent variable.The area under the receiver operating characteristic(ROC)curve was used to analyze the predictive value of the indicators above.Results A total of 66 patients,included 44(66.%)of NPPV success and 22(33.3%)of NPPV failure revealed by bedside cardiopulmonary ultrasound.In comparison with the NPPV success group,the lung ultrasound score,ratio of lung consolidation,E/e’of LV,SPAP,the ratio of right ventricular dysfunction,the ratio of atrial fibrillation and the level of Ccr were significantly evaluated,but the Sm of right ventricular and PaO2/FiO2 were significantly lower in the NPPV failure group(all P<0.05).There were no differences in LVEF,MAPSE,TPASE,diameter of inferi
作者
朱永城
江慧琳
陈晓辉
莫均荣
田朝伟
刘志锋
林珮仪
Zhu Yongcheng;Jiang Huilin;Chen Xiaohui;Mo Junrong;Tian Chaowei;Liu Zhifeng;Lin Peiyi(Department of Emergency,The Second Affiliated Hospital of Guangzhou Medical University,Guangzhou,510260)
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2020年第4期551-555,共5页
Chinese Journal of Emergency Medicine
基金
2017广州市医学重点学科建设项目(2017-2019年)
广东省医学科研基金(A2019183)。
关键词
心源性肺水肿
无创正压通气
床旁心肺超声
急诊室
acute cardiac lung edema
non-invasive positive ventilation
focused echocardiography and lung ultrasound
emergency department
